Cutting – self mutilation reaches a new level

by yourerdoc on December 1, 2008

Its very difficult to rank the most bizarre, fascinating or stressful case out there, but a few come to mind.

I shall never forget a young woman who presented to the ER with what she reported to be a “cut” on her abdomen. I walked up to her bed in a relaxed way, introduced myself, and said “how did you get a cut on your belly?”

She replied with a smile, “I cut myself!”

Something about the way she said that started a couple alarm bells ringing in my head. I asked her if it was an accident, and she said “No, I took a knife and cut myself.” At that point, all bets were off. I worried we were dealing with a major penetrating abdominal injury, and perhaps we were about to start a trauma code.

I pulled back the hospital gown, and found she had about a 10 inch laceration to her abdomen. But that wasn’t all. There was a large amount of gelatinous, yellow-gray goo oozing out of the wound. Now I’ve seen plenty of wound infections, but this was something entirely different. I was afraid to ask, but I had to know. “Um, what is all this stuff in here?” I asked in my most professional, not at all shocked at what I am seeing voice.

“Oh, its noodles, and rice, and some yogurt that I put in there yesterday.” She was clearly happy to be giving me this information and even happier to know that I was completely taken off guard by the whole situation. The poor woman had to be taken to the operating room for a thorough wash out, and later, a psychiatric consult.

Sadly, “cutting” or “self mutiliation” is something we see frequently in the ER. Usually it is less severe than this case, often times patients cut their forearms superficially. It is rarely intended to be a suicide attempt, but it is always something that I take seriously.

Though it does not surprise me that “cutters” are not an uncommon sight at the ER, I find them to be rarely discussed among ER staffers. What do all of you think are the prevailing sentiments about people who come in for self-inflicted wounds? Does it change depending on the severity of the wound and/or the patient attitude? I found one of the strangest things about this case to be the apparent glee and pride this patient had about her cut.

I’m not sure whom you were responding to, but I thought I’d clarify my question just in case. I was wondering not about the psychiatric problems themselves but about ER staffers’ attitudes toward them.

The frustration over patients with minor complaints, annoyance over frequent-flying drunkards, and disdain of lying drug seekers are all much discussed on the ER blog world. I would be curious to hear any of you all’s thoughts on how you think “cutters” are generally regarded in the ER. With pity? Disgust? Annoyance?

Are there trends on how these views change with differences in the patient (proud vs ashamed of injuries, etc) or the staffer (old vs young, male vs female, etc)?

i am ashamed to say i have had to go to the ED several times in the past few years for large lacerations i did to myself. i was not “gleeful” about my situation and had unfortunately become the dreaded “frequent flyer” at this particular hospital. i begged my husband to take me elsewhere, but he would not. Some of the staff were nice enough, but i could definately read the distain and disgust in the actions and voices in many of the staff, one young physician in particular, whose silence, from the time he came in the room until he finished suturing the laceration, spoke volumes. And really, who can blame him, i guess…..?

The last thing patients should feel when they present to the ER with an emergency condition, whether it is medical or psychiatric, is shame. I am well aware that many who work in emergency departments become jaded, and blame patients. I admit I have been shocked by things I have seen. But when a doctor or nurse feels anger, disgust, or disdain for a patient with psychiatric illness, they need to take a step back and think about why they are working in medicine at all.

Frankly, as a long term, chronic SI’er — I’m grateful that my dad (er doc) could get me a stapler. I am perfectly capable of stapling most of my own cuts. I don’t want to be a burden. When I do end up in the ER, usually 3-4 times a year, it’s because I’ve messed Up and hit an artery. Or I’ve simply caused too much damage, often needing 500=1000 stitches at a time.

I have certainly received shock, anger, disgust, and disdain for my actions. But I don’t complain. How can I, really? It’s not like cancer, as much as we wish that we were randomly afflicted with something so dreadful.

Oh, Hannah, i read you entry and i am so sorry. i have had very large cuts and needed stiches and staples, but never to the extent that you have. i wish i knew what to say. in many ways i feel i understand, but of course, no one can totally understand another’s pain. And yet, here’s the kicker…when i read about your having a stapler, i could not help thinking to myself, “Damn, i w i s h i could get one of those…or at least a suture kit”. i actually had a nurse say to me in the ED, “If you’re going to keep doing this, you’d better get a sewing kit”. i should have asked her, then and there, for a suture kit!
Blessings,
tb

Thank you for your compassion and understanding ER Doc!!
I went to the ER to get a cut stitched up and the doc took one look at my arm and said “I can’t sew this up,” and walked back out. It was a fairly minor lac, definitely something he could’ve stitched up in no time. I waited over an hour for someone else to come and see me. That was probably one of the most demeaning experiences of my life, and that doc likely has no idea about the (negative) impact he had on me, and the fact that I still think about him, almost 5 years later.

I’m also someone who needs a stuture kit. I need serios stitches so regularly it’s pathetic.I was taken to ER for the first time at the end of last year, after a failed suicide attempt. The staff were nearly in tears at what my body looked like, and all i recieve alot of sympathy and compassion from them. I haven’t had to put my own stitches in for nearly three months (yes, i’m stupid enoughto use a sewing needle and cotton) and i’m really proud of myself.

Thanks to all the doctors, psychologists and friends who love and support us, even though we’re trying to self destruct.

I also think i understand where the lady is comming from with the spaghetti. I put salt into my 2cm deep cuts, it hurt alot(which i thought was a brilliant idea at the time) but i learnt that it formed a great scab. I used it on burns too. I know it sounds disgusting but i loved it.

Ask The Doc

Q: I have a question congestive heart failure, are there natural remedies for getting rid of water besides Lasix or other drugs?

George - St. Paul, MN

A: There are some natural diuretics including dandelion, ginger, and juniper. But these have fairly modest effects. Most patients who need a diuretic for congestive heart failure or edema are going to need prescription medication.